﻿<!DOCTYPE html>
<html>
	<head>
		<meta charset="UTF-8">
		<title>代理商申请</title>
		<meta name="viewport" content="width=device-width,initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no" />
		<link href="css/mui.min.css" rel="stylesheet" />
	    <link href="css/page.min.css" rel="stylesheet" />
	</head> 
	<body>
		<form class="pd mt60">
		    <p class="mui-input-row">
		        <input type="text" placeholder="请输入代理商名称"/>
		    </p>
		        <p class="mui-input-row">
		        <input type="text" placeholder="请输入代理商地址"/>
		    </p>
		        <p class="mui-input-row">
		        <input type="tel" placeholder="请输入手机号码"/>
		    </p>
		    <div class="mui-input-row">
		        <p class="mui-col-xs-6 fl">
		        	<input type="text" placeholder="请输入验证码"/></p>
		     <p class="mui-col-xs-5 fr">
		     	<button class="mui-btn-success mui-block pt10 pm10">验证码</button>
		     </p> 
		   
		    </div>
		    
		      <p class="mui-input-row">
		        <input type="password" placeholder="密码"/>
		    </p>
		      <p class="mui-input-row">
		        <input type="password" placeholder="重复密码"/>
		    </p>
		    <p class="mui-input-row">
		        <button class="mui-btn-success mui-block pt10 pm10">立即申请</button>
		    </p>
		  
		</form>
		
	</body>
</html>
